Strain-based discoordination imaging during exercise in heart failure with reduced ejection fraction: Feasibility and reproducibility

Louis S. Fixsen (Corresponding author), Philippe C. Wouters, Richard G.P. Lopata, Hareld M.C. Kemps

Onderzoeksoutput: Bijdrage aan tijdschriftTijdschriftartikelAcademicpeer review

1 Citaat (Scopus)
52 Downloads (Pure)


PURPOSE: Various parameters of mechanical dyssynchrony have been proposed to improve patient selection criteria for cardiac resynchronization therapy, but sensitivity and specificity are lacking. However, echocardiographic parameters are consistently investigated at rest, whereas heart failure (HF) symptoms predominately manifest during submaximal exertion. Although strain-based predictors of response are promising, feasibility and reproducibility during exercise has yet to be demonstrated.

METHODS: Speckle-tracking echocardiography was performed in patients with HF at two separate visits. Echocardiography was performed at rest, during various exercise intensity levels, and during recovery from exercise. Systolic rebound stretch of the septum (SRSsept), systolic shortening, and septal discoordination index (SDI) were calculated.

RESULTS: Echocardiography was feasible in about 70-80% of all examinations performed during exercise. Of these acquired views, 84% of the cine-loops were suitable for analysis of strain-based mechanical dyssynchrony. Test-retest variability and intra- and inter-operator reproducibility at 30% and 60% of the ventilatory threshold (VT) were about 2.5%. SDI improved in the majority of patients at 30% and 60% of the VT, with moderate to good agreement between both intensity levels.

CONCLUSION: Although various challenges remain, exercise echocardiography with strain analysis appears to be feasible in the majority of patients with dyssynchronous heart failure. Inter- and intra-observer agreement of SRSsept and SDI up to 60% of the VT were comparable to resting values. During exercise, the extent of SDI was variable, suggesting a heterogeneous response to exercise. Further research is warranted to establish its clinical significance.

Originele taal-2Engels
Aantal pagina's11
TijdschriftBMC Cardiovascular Disorders
Nummer van het tijdschrift1
StatusGepubliceerd - 25 mrt. 2022

Bibliografische nota

© 2022. The Author(s).


European Union’s Horizon Europe research and innovation programme642612


    Duik in de onderzoeksthema's van 'Strain-based discoordination imaging during exercise in heart failure with reduced ejection fraction: Feasibility and reproducibility'. Samen vormen ze een unieke vingerafdruk.

    Citeer dit